Permit CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2006 -00136
s ,Lj. M1•III DATE ISSUED: 4/10/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101AD -02900
SITE ADDRESS: 12755 SW 69TH AVE 100 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 031 JURISDICTION: TIG
Project Description: INSTALL DUCTLESS MINI SPLIT HEAT PUMP. (IN WALL) VALUE: 1500
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
ROTH, J T JR + THERESA A + Description Date Amount
ZOUCHA, MICHAEL S
12600 SW 72ND AVE #200 [MECH] Permit Fee 4/10/200E $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 4/10/200E $5.80
Total $78.30
Phone:
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -557 -2220
FAX 503 -557 -0919
Reg #: LIC 72623
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: jatv Permittee Signature: 01/1 (fit
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Fipr 03 06 01:34a TriCountyTemp 5035570919 p.1
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Mechanical Permit Application • FOR OFFICE USE ONLY
City of Tigard RECEIVED A Received
Date/By; Plan Rev 41 fro/a& _1'3 Permit No.m6cdive, .. ea 3'
13125 SW Hall Blvd., Tigard, OR 97223 iew
Phone: 503.639.4171 Fax: 503.598.1960 4..... .:. Datedly: Other Permit:
Inspection Line: 503.639.4175 2006 ,11. Date Ready/By: RI See Page 2 for
Inteinet: www.ci.tigard.or.us Notified/Method: " Supplemental Information
CITY our 9J , .. _., ,, , , ,
•-•-•v1 ' 45 ,-, ;:ti'100,4 4- !!rA:-q4 .i.;•'=',. ZedkikaAt4t14,1.±titeriliii 11.WCHECKLIST
CI New construction Addition/alteration/replacement
, Mechanical permit fees' are based on the value of the work
)gt
performed. indicate the value (rounded :o the nearest dollar) of all
0 Demolition D Other: i mechanical materials, equipment, labor, ob-head, and profit.
Value S
.1 .•,.. : .qT. 4 .:: ; •:'i'''',..i;• -. 1: 7 ; ' : : : 7 7, iI!'421 - '7 : '.. - : : . . ,... ,., .., .;._. , ,.._
:: *
0 1 - and 2-family dwelling ;g Commercial/industrial 0 Accessory building SYSTEMS
For special information use checklist.
0 Multi 0 Master builder 0 Other: Description 1 Qty. I Ea. Total
1.011i %"• .."-':''-;' .."- Heating/cooling
Job site address: /2_164W Ave efe, I Ob Air conditioning or heat pump
(requires site plan showing placement) , 14.00
City/State/ZT: T 2z3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldgJapt. no.: Project name: •
les heat pump - I 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system i 14.00
1 Residential boiler (radiator or 1
hydronic)
1 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above I 10.00
Subdivision: Lot no.:
Other: 1 10.00
Tax map/parcel no.: Other fuel appliances 1
'''.. ' '.:::,.....;*'-. ■.;-,:-i-,..,?;-'?'!*.':;1-"`!iik-gektiffitK....6k. WORK :::- ., . Water heater . 1 10.00 1
"" ... ..':i . .. : . 4: :'.... , 1,:: . '... •;. ,........ : .. .. ..7:: !=i..., ' .'...,: i.. . I 10.00 ; i
-
11160 dikale&5 01441 oprit Cheat pun* Gas fireplace
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
:.,...: t. . ,,: ..:4 '
.''...i: ... - i' . '''' . -.- ..' ',...%: 'n . • ::::. : Chimnerliner/flue/vent 10.00
: r .;:..■! • >! . ;,•;:.'.'i-:.:'::: 1 ; 1 .:: : : - .,,TINT...;..i.:;' !. o ther: 10.00
Name: lelend Higyite Environmental exhaust and ventilation
Range hood/other kitchen
Address: ealine... equipment 10.00 I 1
City/State/ZIP: Clothes dryer exhaust 10.00 I I
Single-duct exhaust (bathrooms,
Phone: (5Q 11.O spe60 Fax: ( ) toilet compartments, utility rooms) , 6.80
. -.... . -.
.•-,!..‘:::::::;0 -':ii y:S. _,.,.: ;:...: Attic/crawlspace fans 10.00
i
Other: 10.00
Business name: In (au Canto) Fuel piping
Contact name: .1)1(ine S5.40 for first four; 51.00 for each additional
Address: 0100 E3 C c(CkaitY1CiS Rivor-brht) Fumace, etc.
Gas heat pump I 1
City/State/ZIP: Cregon Ci C12 C(704.5 Wall/suspended/unit
•
Photte: (5-2) 557--9290 Fax: : (603) 557-6414i Water heater ,
' Fireplace ,
E-mail: Range
' 'Ti - ;;r: - : - .1; - .:.-.ifl Barbecue
. : , :er.:,..j. , :. , :r. - 4'.r4r......:': ,, ..: , ... , .?:,-. -, ;::::: ,, :,;.. - .7 ,i.‘.., :;,.., . ... ,..., .....,....... "..'fit',!..:• 7 ,.... ir,, ..... '+.,;,••,.:•'• • - rl.; ,..::, ; , ,„. ,:
Business name: Tr' Caln Temp Corrtrel Clothes dryer (gas)
Other: ( 1 •
Address: ?) aMMOS Rik/CI % 14 -.
City/State/ZEE': OrTon • i tc. C._ cat/--- inimum perrnit
cat/--- ....5 1 ' Subtotal
Phone: (5)) 55 _222.o I Fax: ( S I T) SS7 -6(1161 M fee (S72.50)
Plan review (25% of permit fee) '
CCB lic.: 'lag 23 State surcharge (8% of permit fee) rya 3
,
TOTAL PERMIT FEE.
0 C
Authorized signature: 4.-71-e .7-qa This permit application expires if a permit ill not obtained within 180
days after it has been accepted as complete.
Print name: b ,1M,364 I Date: 411(f)(0 I • Fee methodology set by Tri-County Building Industry service Board
OBuilding■Permits \MEC.Per.nitApq.doc 12103 440-4611T ( I 1/02;COM/WEB)
C!TY _OF TIGARD .
BUILDING DIVISION PERMIT #: M C: 0[lfi- Cl(i'E3f3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/10/2006
Phone: (503) 639 -4171 47 � p , 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/14/2006 TIME: 7:07AM PAGE: 7'1
SITE ADDRESS: 12755 SW 69TH AVE 100 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 031 TYPE OF USE:
PROJECT NAME: LEGEND HOMES
DESCRIPTION: INSTALL. DUCTLESS MINI SPLIT HEAT PUMP. (IN WALL.) VALUE: 1600
OWNER: ROTH, J T JR ¢ THERESA A N, PHONE #:
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503_557 - 2220
Inspection Request Scheduled For: Date: 4/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 028043-01 ?•iO3- 557.2 220 N
Corrections /Comments /Instructions:
34111
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL 11 CALL kOR INSPECTION 111 ADDITIeNAL FEES ASSESSED
Inspector: � Date: V !P Phone #: (503) 718 -240 -'